Conclusion
For the foreseeable future, there will still be a need and a place for general anesthesia in obstetrics. To prevent the associated risks more research is needed. For example, does cricoid pressure decrease the risk of pulmonary aspiration or does it add one more hazard to intubation? Is the decrease in pulmonary aspiration due to cricoid pressure or is it due to other measures such as avoidance of solids during labour and antacid prophylaxis? Answers to these questions may increase the safety of general anesthesia. Although there will always be a concern when general anesthesia is administered to the obstetric patient, appropriate patient selection and attention to detail should result in general anesthesia being a winning combination for the mother and her fetus/neonate.
Article PDF
Similar content being viewed by others
References
Department of Health and others. Why mothers die 1997–1999. The Confidential Enquiries into Maternal Deaths in the United Kingdom. London: RCOG Press; 2001.
Hawkins JL, Koonin LM, Palmer SK, Gibbs CP. Anesthesia-related deaths during obstetric delivery in the United States, 1979–1990. Anesthesiology 1997; 86: 277–84.
Pilkington S, Carli F, Dakin MJ, et al. Increase in Mallampati score during pregnancy. Br J Anaesth 1995; 74: 638–42.
Farcon EL, Kim MH, Marx GF. Changing Mallampati score during labour. Can J Anaesth 1994; 41: 50–1.
Bhavani-Shankar K, Lynch EP, Datta S. Airway changes during cesarean hysterectomy. Can J Anesth 2000; 47: 338–41.
Baraka AS, Hanna MT, Jabbour SI, et al. Preoxygenation of pregnant and nonpregnant women in the head-up versus supine position. Anesth Analg 1992; 75: 757–9.
O’Sullivan G, Scrutton M. NPO during labor. Is there any scientific validation? Anesthesiology Clin North America 2003; 21: 87–98.
Vanner RG. Mechanisms of regurgitation and its prevention with cricoid pressure. Intern J Obstet Anesth 1993; 2: 207–15.
Mendelson CL. The aspiration of stomach contents into the lungs during obstetric anesthesia. Am J Obstet Gynecol 1946; 52: 191–204.
Hawthorne L, Wilson R, Lyons G, Dresner M. Failed intubation revisited: 17-yr experience in a teaching maternity unit. Br J Anaesth 1996; 76: 680–4.
Barnardo PD, Jenkins JG. Failed tracheal intubation in obstetrics: a 6-year review in a UK region. Anaesthesia 2000; 55: 690–4.
Ezri T, Szmuk P, Stein A, Konichezky S, Hagai T, Geva D. Peripartum general anaesthesia without tracheal intubation: incidence of aspiration pneumonia. Anaesthesia 2000; 55: 421–6.
Han TH, Brimacombe J, Lee EJ, Yang HS. The laryngeal mask airway is effective (and probably safe) in selected healthy parturients for elective cesarean section: a prospective study of 1067 cases. Can J Anesth 2001; 48: 1117–21.
Sellick BA. Cricoid pressure to control regurgitation of stomach contents during induction of anaesthesia. Lancet 1961; 2: 404–6.
Tournadre JP, Chassard D, Berrada KR, Bouletreau P. Cricoid cartilage pressure decreases lower esophageal sphincter tone. Anesthesiology 1997; 86: 7–9.
Smith KJ, Dobranowski J, Yip G, Dauphin A, Choi PT. Cricoid pressure displaces the esophagus: an observational study using magnetic resonance imaging. Anesthesiology 2003; 99: 60–4.
Meek T, Gittins N, Duggan JE. Cricoid pressure: knowledge and performance among anaesthetic assistants. Anaesthesia 1999; 54: 59–62.
Vanner RG, Clarke P, Moore WJ, Raftery S. The effect of cricoid pressure and neck support on the view at laryngoscopy. Anaesthesia 1997; 52: 896–900.
Levy DM. Inhalational induction of anaesthesia for caesarean section: not to be sniffed at? (Editorial). Intern J Obstet Anesth 2002; 11: 235–7.
Ong BY, Cohen MM, Palahniuk RJ. Anesthesia for cesarean section-effects on neonates. Anesth Analg 1989; 68: 270–5.
Marx GF, Luykx WM, Cohen S. Fetal-neonatal status following caesarean section for fetal distress. Br J Anaesth 1984; 56: 1009–12.
Gunka VB, Douglas MJ. How fast are we? Anesthesiology 2001; 94: A85 (abstract).
Korhonen J, Kariniemi V. Emergency cesarean section: the effect of delay on umbilical arterial gas balance and Apgar scores. Acta Obstet Gynecol Scand 1994; 73: 782–6.
Crosby ET, Cooper RM, Douglas MJ, et al. The unanticipated difficult airway with recommendations for management. Can J Anaesth 1998; 45: 757–76.
Johnson RV, Lyons GR, Wilson RC, Robinson AP. Training in obstetric general anaesthesia: a vanishing art? Anaesthesia 2000; 55: 179–83.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Douglas, J. General anesthesia for obstetrics: a deadly or a winning combination. Can J Anesth 51 (Suppl 1), R17–R20 (2004). https://doi.org/10.1007/BF03018335
Issue Date:
DOI: https://doi.org/10.1007/BF03018335